Proposed taxonomy of audit and related activities.

The quality of the current debate on medical audit has been compromised by semantic confusion. A simple taxonomy is suggested for six frequently cited terms: review, audit, evaluation, surveillance, appraisal and monitoring. Review is usually a clinically based professional scrutiny of a particular service. Continuous peer review is audit, which may be internal or external. Evaluation involves measuring health indices in relation to a reference point, such as an objective or a control group, and has a strong statistical or epidemiological flavour, as has surveillance which may be regarded as continuous evaluation. Appraisal is the managerial form of evaluation, while monitoring is its routine counterpart. Thus, review and audit are primarily clinically oriented activities, evaluation and surveillance tend to be more epidemiological, and appraisal and monitoring are largely managerial. Review, evaluation and appraisal may be described as one-off quality assessment methods, and audit, surveillance and monitoring as routine ones. This classification attributes a distinct theoretical identity to each of the six categories though they are not mutually exclusive. It also delineates boundaries between the necessarily separate professional worlds inhabited by clinicians, public health staff and managers, and places various quality assessment methods within appropriate time-frames. The scheme preserves the fundamental integrity of the six activities which collectively comprise the intelligence gathering arm of quality assurance.